Cultural Authority and Food Choices: How Intergenerational Power Shapes Maternal Diet in Rural South Africa

Background Maternal malnutrition remains a persistent public health challenge in South Africa, affecting both maternal and child health outcomes. Dietary practices during pregnancy and lactation are shaped by complex social dynamics that extend beyond individual choice. This study explored maternal dietary practices during pregnancy, defined as the foods women reported consuming, avoiding, substituting, or concealing, and examined how cultural norms and intergenerational power relations influenced these practices within the context of routine antenatal nutrition counselling. Methods We conducted a qualitative study in Capricorn district of Limpopo province (March–October 2025). Data comprised focus group discussions (n=22) and individual interviews (n=13) with 150 participants including pregnant women, grandmothers, fathers, community leaders, community health workers, mother mentors (lay peer counsellors attached to clinics who support pregnant women and new mothers), and healthcare providers. Data were analysed using reflexive thematic analysis. Interpretation drew on the Social Ecological Model and Bourdieu's Theory of Practice. Findings Four interconnected themes explained dietary behaviour. First, elder women, especially grandmothers and mothers-in-law, held decisive authority based on experiential knowledge framed as care, which often was accepted over healthcare advice. Second, pregnant women balanced competing guidance, using respectful deference in public and selective adherence in private. Third, poverty, distance, and poor infrastructure made clinical advice largely unattainable. Fourth, digital messaging and peer networks provided supplementary information that supported dialogue but did not displace elder authority. Interpretation Reported maternal dietary practice is shaped by intergenerational power dynamics and by resource constraints rather than by nutritional knowledge alone. Grandmothers enforce cultural dietary restrictions that conflict with clinical guidance, while pregnant women use public deference and private adaptation to navigate competing advice. Nutrition interventions must engage elders as partners and employ culturally respectful harm-reduction strategies.